---
title: "QoR-40 after Arthroscopic Meniscectomy: Remimazolam vs Propofol TIVA"
id: "plos-one-12-quality-of-recovery-after-arthroscopic-meniscectomy-with-remimazolam-or"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-12-quality-of-recovery-after-arthroscopic-meniscectomy-with-remimazolam-or"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360759"
published_at: "2026-10-15T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# QoR-40 after Arthroscopic Meniscectomy: Remimazolam vs Propofol TIVA
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-12-quality-of-recovery-after-arthroscopic-meniscectomy-with-remimazolam-or
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360759)
- **Published At:** 2026-10-15T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- Randomized trial compared **remimazolam**-based versus **propofol**-based total intravenous anesthesia (TIVA) in adult patients undergoing elective arthroscopic meniscectomy. 80 patients were randomized; 71 completed the POD 1 QoR-40 and were analyzed (36 propofol, 35 remimazolam). - Primary endpoint: global **QoR-40** score on postoperative day (POD) 1; scores range 40–200 with higher better. - Global POD 1 QoR-40: Propofol 166.1 ± 16.8 vs Remimazolam 170.6 ± 13.6 (mean difference −4.5; 95% CI −11.8 to 2.7; P = 0.218). No statistically significant difference detected. - Domain-level finding: the emotional-state domain score was higher in the Remimazolam group (37.0 ± 4.3 vs 39.2 ± 2.5; mean difference −2.2; 95% CI −3.9 to −0.6; P = 0.009) in an exploratory analysis. - Hemodynamic data: intraoperative hypotension requiring ephedrine occurred more often with propofol (44.4% vs 17.1%; P = 0.013), indicating greater hemodynamic stability with remimazolam. - Recovery profile: remimazolam was associated with slower emergence metrics—time to full alertness median 18 [15–24] vs 37 [31–45] minutes (P < 0.001) and longer PACU stay 30 [30–39] vs 38 [30–50] minutes (P = 0.008). - Secondary measures (anesthetic and opioid consumption, pain scores, PONV) were reported as exploratory and analyzed without multiplicity adjustment. - Missing data: 9 patients lacked POD 1 QoR-40 due to administrative failure; primary analysis was complete-case (n = 71) with sensitivity analyses including multiple imputation as described by the authors. - Trial conduct: single-center, randomized, allocation concealed; attending anesthesiologists were not blinded due to infusion method differences, while outcome assessors and patients remained blinded.
## Clinical Analysis & Structured Key Points
Quality of recovery after arthroscopic meniscectomy with remimazolam or propofol anesthesia: A randomized controlled trial | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Reader Comments Figures Figures Abstract Background Anesthetic technique may influence postoperative quality of recovery (QoR). Remimazolam may offer hemodynamic stability and favorable early recovery characteristics, but its effect on patient-reported QoR compared with propofol remains unclear. This is particularly relevant in minor orthopedic surgery, where QoR is a principal outcome. This randomized controlled trial compared postoperative QoR between propofol-based and remimazolam-based total intravenous anesthesia (TIVA) using the QoR-40 questionnaire. Materials and methods Eighty adult patients undergoing elective arthroscopic meniscectomy were randomly assigned to propofol-based or remimazolam-based TIVA; 71 patients completed the QoR-40 questionnaire and were included in the final analysis (36 in the Propofol group, 35 in the Remimazolam group). The primary outcome was the global QoR-40 score on postoperative day (POD) 1. Secondary outcomes included intraoperative hemodynamic variables, anesthetic and analgesic requirements, postoperative recovery profiles, pain scores, and postoperative nausea and vomiting. Results Global QoR-40 scores on POD 1 did not differ significantly between the Propofol and Remimazolam groups (166.1 ± 16.8 vs. 170.6 ± 13.6; mean difference −4.5, 95% CI −11.8 to 2.7; P = 0.218). In an exploratory analysis, the emotional-state domain scores were higher in the Remimazolam group (37.0 ± 4.3 vs. 39.2 ± 2.5; mean difference −2.2, 95% CI −3.9 to −0.6; P = 0.009). The Remimazolam group had a longer time to full alertness (18 [15–24] vs. 37 [31–45] min; P 0.20 indicating meaningful imbalance. To test robustness to chance imbalance, the primary outcome was reanalyzed in a linear model including treatment group and the imbalanced baseline characteristics as covariates; where two imbalanced variables were collinear measures of the same construct, only one was retained. Missing POD 1 data were addressed by multiple imputation using fully conditional specification with 20 imputations (random seed 12345), including all 80 randomized patients; the imputation model included treatment group, age, body mass index, ASA physical status, asthma, and the preoperative QoR-40 domain scores, and estimates were pooled using Rubin’s rules. Because multiple imputation assumes data are missing at random, characteristics of patients with and without questionnaire data were compared ( S1 Table ). Secondary and domain-specific outcomes — QoR-40 domains, hemodynamic variables, anesthetic and vasoactive requirements, recovery profiles, pain scores, rescue analgesia, and PONV — were analyzed without multiplicity adjustment and are exploratory. Perioperative repeated measures (MAP, HR, PSI) were analyzed using linear mixed-effects models with fixed effects for treatment group, categorical time, and their interaction. No random effects were included; repeated measurements within each participant were modeled using an unstructured covariance matrix, and the pre-induction measurement was included as the first level of the repeated-measures time factor rather than being entered as a separate covariate. MAP and HR were modeled across five intraoperative and two post-anesthesia care unit time points, and PSI across five intraoperative time points. Fixed effects were evaluated using Type 3 tests, and between-group comparisons at individual time points were interpreted as exploratory without adjustment for multiplicity. Statistical significance was defined as P 0.999). Accordingly, 71 patients were included in the primary complete-case analysis, with 36 in the Propofol group and 35 in the Remimazolam group. A comparison of patients with and without postoperative QoR-40 data is presented in S1 Table . Download: PNG larger image TIFF original image Fig 1. CONSORT diagram of patient recruitment. https://doi.org/10.1371/journal.pone.0360759.g001 No baseline characteristic differed significantly between the two groups ( Table 1 ). Age, weight, BMI, ASA physical status, and asthma exceeded the prespecified imbalance threshold (standardized mean difference > 0.20); weight was excluded from adjusted models owing to collinearity with BMI. The QoR-40 scores are summarized in Table 2 . The preoperative QoR-40 scores were not different between the two groups (P = 0.872). On POD 1, the global QoR-40 score was 166.1 ± 16.8 in the Propofol group and 170.6 ± 13.6 in the Remimazola
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